OD (2)

Everyone wants to talk about overdoses these days.  My job is now not known for daring rescues and fiery crashes, but our menial contribution to a disease that has finally caught public attention.  I am baited upon meeting new people and I fall for it.  "What's your most common type of call?"  "Have you ever been on a heroin overdose?"  "Do you carry narcan?" Ah, damn!  Next thing I know I am in a conversation about the good old days, how kids are spoiled, or 'why don't they all just quit?'.

One of my first calls as a student was for an overdose.  My first.  My preceptors 5000th. "Pump the brakes"  I am told. No, you won't get to intubate this patient. At best you will finish this call and not have been punched or yelled at.

So, no, giving narcan is not news to me. Giving it on the regular in a town of 6000 residents, that is noteworthy.  That is something we've all noticed. 

One thing I resolved to do was not "allow" these patients to refuse. Any patient who is alert and oriented may refuse care and transport to the hospital. The opposite of that is kidnapping and I'm not into that.
These overdoses, while they start out unconscious, rapidly improve and are then often quite fervent in their desire to stay home and be left alone.  This poses a problem for me.  Firstly, I have to allow a drug addled (but oriented) person to stay home. They are not arrested, scared, charged, or even mildly inconvenienced, a fact that annoys me.  They are all but rewarded for their keen overdosing skills. Secondly, the half life of narcotics is much longer than that of the reversal agent. These people could find themselves unconscious again even without taking more drugs.  And I always worry that when they are found dead the next day, that will quite easily fall on me, both emotionally and legally.

One colleague shares my sentiment but takes his tactics to the extreme, and doesn't treat these people until they are already in the ambulance.  This has caused him to have to summon police, get into fights and twice have a patient jump from an all but moving ambulance in the middle of the street. This tactic does not work.
I prefer to gently wake these people up, gather them up and walk them swiftly to the ambulance. As they begin to feel more normal they can be (usually) easily convinced to not jump out of the ambulance and to do everyone (especially themselves) a favor and just come on down to the ER.  So far so good. No messes have been made.
Once they get to the ER, are they suddenly compelled to give up the drugs and reform? No. But do they have the chance?  Yes.  This is pretty idealistic, I know, but I have to feel like I am doing something. Anything to never see another dead 25 year old.

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